Provider Demographics
NPI:1861824054
Name:LEE, JAE JESSE (LADC)
Entity Type:Individual
Prefix:
First Name:JAE
Middle Name:JESSE
Last Name:LEE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 APPLE STREET
Mailing Address - Street 2:SUITE 225
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-335-5625
Mailing Address - Fax:
Practice Address - Street 1:495 APPLE ST
Practice Address - Street 2:SUITE 225
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3553
Practice Address - Country:US
Practice Address - Phone:775-335-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)